|
8CMX5M COMPRILAN
|
Facility
|
OP
|
$19.00
|
|
| Hospital Charge Code |
4471080
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$6.46 |
| Max. Negotiated Rate |
$15.30 |
| Rate for Payer: Aetna of NY Commercial |
$13.30
|
| Rate for Payer: Aetna of NY Medicare |
$8.74
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$14.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$14.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$7.03
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$9.50
|
| Rate for Payer: Cash Price |
$14.25
|
| Rate for Payer: CDPHP Commercial |
$15.30
|
| Rate for Payer: CDPHP Medicare |
$7.03
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$15.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$15.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$15.20
|
| Rate for Payer: EmblemHealth Medicaid |
$15.20
|
| Rate for Payer: EmblemHealth Medicare |
$6.46
|
| Rate for Payer: EmblemHealth Select Care |
$13.68
|
| Rate for Payer: Fidelis Medicare |
$7.24
|
| Rate for Payer: Galaxy Health Commercial |
$12.35
|
| Rate for Payer: Hamaspik Choice Medicare |
$7.03
|
| Rate for Payer: Humana Medicare |
$7.03
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$13.30
|
| Rate for Payer: Local 1199SEIU Medicare |
$8.74
|
| Rate for Payer: MVP Health Care of NY Commercial |
$14.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$10.70
|
| Rate for Payer: MVP Health Care of NY Medicare |
$7.38
|
| Rate for Payer: United Healthcare Medicare |
$7.03
|
| Rate for Payer: WellCare Medicare |
$10.45
|
|
|
8CMX5M COMPRILAN
|
Facility
|
IP
|
$19.00
|
|
| Hospital Charge Code |
4471080
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$12.35 |
| Max. Negotiated Rate |
$12.35 |
| Rate for Payer: Cash Price |
$14.25
|
| Rate for Payer: Galaxy Health Commercial |
$12.35
|
|
|
8FR 3CC FOLEY
|
Facility
|
OP
|
$24.00
|
|
| Hospital Charge Code |
4478207
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.16 |
| Max. Negotiated Rate |
$19.32 |
| Rate for Payer: Aetna of NY Commercial |
$16.80
|
| Rate for Payer: Aetna of NY Medicare |
$11.04
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$18.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$18.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$8.88
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$12.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: CDPHP Commercial |
$19.32
|
| Rate for Payer: CDPHP Medicare |
$8.88
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$19.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$19.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$19.20
|
| Rate for Payer: EmblemHealth Medicaid |
$19.20
|
| Rate for Payer: EmblemHealth Medicare |
$8.16
|
| Rate for Payer: EmblemHealth Select Care |
$17.28
|
| Rate for Payer: Fidelis Medicare |
$9.15
|
| Rate for Payer: Galaxy Health Commercial |
$15.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$8.88
|
| Rate for Payer: Humana Medicare |
$8.88
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$16.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$11.04
|
| Rate for Payer: MVP Health Care of NY Commercial |
$18.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$13.51
|
| Rate for Payer: MVP Health Care of NY Medicare |
$9.32
|
| Rate for Payer: United Healthcare Medicare |
$8.88
|
| Rate for Payer: WellCare Medicare |
$13.20
|
|
|
8FR 3CC FOLEY
|
Facility
|
IP
|
$24.00
|
|
| Hospital Charge Code |
4478207
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$15.60 |
| Max. Negotiated Rate |
$15.60 |
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Galaxy Health Commercial |
$15.60
|
|
|
8FR CATHETER KIT 10820
|
Facility
|
IP
|
$13.00
|
|
| Hospital Charge Code |
4479287
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$8.45 |
| Max. Negotiated Rate |
$8.45 |
| Rate for Payer: Cash Price |
$9.75
|
| Rate for Payer: Galaxy Health Commercial |
$8.45
|
|
|
8FR CATHETER KIT 10820
|
Facility
|
OP
|
$13.00
|
|
| Hospital Charge Code |
4479287
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$4.42 |
| Max. Negotiated Rate |
$10.46 |
| Rate for Payer: Aetna of NY Commercial |
$9.10
|
| Rate for Payer: Aetna of NY Medicare |
$5.98
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$9.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$9.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$4.81
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$6.50
|
| Rate for Payer: Cash Price |
$9.75
|
| Rate for Payer: CDPHP Commercial |
$10.46
|
| Rate for Payer: CDPHP Medicare |
$4.81
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$10.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$10.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$10.40
|
| Rate for Payer: EmblemHealth Medicaid |
$10.40
|
| Rate for Payer: EmblemHealth Medicare |
$4.42
|
| Rate for Payer: EmblemHealth Select Care |
$9.36
|
| Rate for Payer: Fidelis Medicare |
$4.95
|
| Rate for Payer: Galaxy Health Commercial |
$8.45
|
| Rate for Payer: Hamaspik Choice Medicare |
$4.81
|
| Rate for Payer: Humana Medicare |
$4.81
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$9.10
|
| Rate for Payer: Local 1199SEIU Medicare |
$5.98
|
| Rate for Payer: MVP Health Care of NY Commercial |
$9.75
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$7.32
|
| Rate for Payer: MVP Health Care of NY Medicare |
$5.05
|
| Rate for Payer: United Healthcare Medicare |
$4.81
|
| Rate for Payer: WellCare Medicare |
$7.15
|
|
|
.9% SODCH 1000ML IRRIGATION BAG
|
Facility
|
IP
|
$4.00
|
|
| Hospital Charge Code |
4479241
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.60 |
| Max. Negotiated Rate |
$2.60 |
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Galaxy Health Commercial |
$2.60
|
|
|
.9% SODCH 1000ML IRRIGATION BAG
|
Facility
|
OP
|
$4.00
|
|
| Hospital Charge Code |
4479241
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.36 |
| Max. Negotiated Rate |
$3.22 |
| Rate for Payer: Aetna of NY Commercial |
$2.80
|
| Rate for Payer: Aetna of NY Medicare |
$1.84
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$3.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$3.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$1.48
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$2.00
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: CDPHP Commercial |
$3.22
|
| Rate for Payer: CDPHP Medicare |
$1.48
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$3.20
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$3.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$3.20
|
| Rate for Payer: EmblemHealth Medicaid |
$3.20
|
| Rate for Payer: EmblemHealth Medicare |
$1.36
|
| Rate for Payer: EmblemHealth Select Care |
$2.88
|
| Rate for Payer: Fidelis Medicare |
$1.52
|
| Rate for Payer: Galaxy Health Commercial |
$2.60
|
| Rate for Payer: Hamaspik Choice Medicare |
$1.48
|
| Rate for Payer: Humana Medicare |
$1.48
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$2.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$1.84
|
| Rate for Payer: MVP Health Care of NY Commercial |
$3.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$2.25
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1.55
|
| Rate for Payer: United Healthcare Medicare |
$1.48
|
| Rate for Payer: WellCare Medicare |
$2.20
|
|
|
.9 % SOD CHLOR. 3000ML IRRIGA
|
Facility
|
IP
|
$28.00
|
|
| Hospital Charge Code |
4471596
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$18.20 |
| Max. Negotiated Rate |
$18.20 |
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Galaxy Health Commercial |
$18.20
|
|
|
.9 % SOD CHLOR. 3000ML IRRIGA
|
Facility
|
OP
|
$28.00
|
|
| Hospital Charge Code |
4471596
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$9.52 |
| Max. Negotiated Rate |
$22.54 |
| Rate for Payer: Aetna of NY Commercial |
$19.60
|
| Rate for Payer: Aetna of NY Medicare |
$12.88
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$21.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$21.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$10.36
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$14.00
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: CDPHP Commercial |
$22.54
|
| Rate for Payer: CDPHP Medicare |
$10.36
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$22.40
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$22.40
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$22.40
|
| Rate for Payer: EmblemHealth Medicaid |
$22.40
|
| Rate for Payer: EmblemHealth Medicare |
$9.52
|
| Rate for Payer: EmblemHealth Select Care |
$20.16
|
| Rate for Payer: Fidelis Medicare |
$10.67
|
| Rate for Payer: Galaxy Health Commercial |
$18.20
|
| Rate for Payer: Hamaspik Choice Medicare |
$10.36
|
| Rate for Payer: Humana Medicare |
$10.36
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$19.60
|
| Rate for Payer: Local 1199SEIU Medicare |
$12.88
|
| Rate for Payer: MVP Health Care of NY Commercial |
$21.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$15.76
|
| Rate for Payer: MVP Health Care of NY Medicare |
$10.88
|
| Rate for Payer: United Healthcare Medicare |
$10.36
|
| Rate for Payer: WellCare Medicare |
$15.40
|
|
|
ABDOMINAL PARACENTESIS (DIAGNOSTIC OR TH
|
Facility
|
OP
|
$2,594.00
|
|
|
Service Code
|
HCPCS 49082
|
| Hospital Charge Code |
4609609
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$250.00 |
| Max. Negotiated Rate |
$2,088.17 |
| Rate for Payer: Aetna of NY Commercial |
$955.00
|
| Rate for Payer: Aetna of NY Medicare |
$1,193.24
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$950.93
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,189.18
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$959.78
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,297.00
|
| Rate for Payer: Cash Price |
$1,945.50
|
| Rate for Payer: Cash Price |
$1,945.50
|
| Rate for Payer: Cash Price |
$1,945.50
|
| Rate for Payer: Cash Price |
$1,945.50
|
| Rate for Payer: CDPHP Commercial |
$2,088.17
|
| Rate for Payer: CDPHP Medicare |
$959.78
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,182.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,075.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,075.20
|
| Rate for Payer: EmblemHealth Medicaid |
$2,075.20
|
| Rate for Payer: EmblemHealth Medicare |
$881.96
|
| Rate for Payer: EmblemHealth Select Care |
$1,064.00
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$250.00
|
| Rate for Payer: Fidelis Medicare |
$988.57
|
| Rate for Payer: Galaxy Health Commercial |
$1,686.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$959.78
|
| Rate for Payer: Humana Medicare |
$959.78
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$955.00
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,193.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,174.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$881.00
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,007.77
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$980.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$863.69
|
| Rate for Payer: United Healthcare Commercial |
$980.00
|
| Rate for Payer: United Healthcare Medicare |
$959.78
|
| Rate for Payer: WellCare Medicare |
$1,426.70
|
|
|
ABDOMINAL PARACENTESIS (DIAGNOSTIC OR TH
|
Facility
|
IP
|
$2,594.00
|
|
|
Service Code
|
HCPCS 49082
|
| Hospital Charge Code |
4609609
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,686.10 |
| Max. Negotiated Rate |
$1,686.10 |
| Rate for Payer: Cash Price |
$1,945.50
|
| Rate for Payer: Galaxy Health Commercial |
$1,686.10
|
|
|
ABDOM PARACENTESIS DX/THER W/IMAGING GUIDANCE
|
Facility
|
OP
|
$2,594.00
|
|
|
Service Code
|
HCPCS 49083
|
| Hospital Charge Code |
4201079
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$475.00 |
| Max. Negotiated Rate |
$2,088.17 |
| Rate for Payer: Aetna of NY Commercial |
$1,815.80
|
| Rate for Payer: Aetna of NY Medicare |
$1,193.24
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$1,945.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$1,945.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$959.78
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$1,297.00
|
| Rate for Payer: Cash Price |
$1,945.50
|
| Rate for Payer: Cash Price |
$1,945.50
|
| Rate for Payer: CDPHP Commercial |
$2,088.17
|
| Rate for Payer: CDPHP Medicare |
$959.78
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$1,815.80
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$2,075.20
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$2,075.20
|
| Rate for Payer: EmblemHealth Medicaid |
$2,075.20
|
| Rate for Payer: EmblemHealth Medicare |
$881.96
|
| Rate for Payer: EmblemHealth Select Care |
$1,686.10
|
| Rate for Payer: Fidelis Medicare |
$988.57
|
| Rate for Payer: Galaxy Health Commercial |
$1,686.10
|
| Rate for Payer: Hamaspik Choice Medicare |
$959.78
|
| Rate for Payer: Humana Medicare |
$959.78
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$1,815.80
|
| Rate for Payer: Local 1199SEIU Medicare |
$1,193.24
|
| Rate for Payer: MVP Health Care of NY Commercial |
$1,945.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$1,460.42
|
| Rate for Payer: MVP Health Care of NY Medicare |
$1,007.77
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$475.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$863.69
|
| Rate for Payer: United Healthcare Commercial |
$475.00
|
| Rate for Payer: United Healthcare Medicare |
$959.78
|
| Rate for Payer: WellCare Medicare |
$1,426.70
|
|
|
ABDOM PARACENTESIS DX/THER W/IMAGING GUIDANCE
|
Facility
|
IP
|
$2,594.00
|
|
|
Service Code
|
HCPCS 49083
|
| Hospital Charge Code |
4201079
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1,686.10 |
| Max. Negotiated Rate |
$1,686.10 |
| Rate for Payer: Cash Price |
$1,945.50
|
| Rate for Payer: Galaxy Health Commercial |
$1,686.10
|
|
|
AB; HIV-1 & HIV-2 SGL ASSAY
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
HCPCS 86703
|
| Hospital Charge Code |
4301302
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$15.59 |
| Max. Negotiated Rate |
$1,559.00 |
| Rate for Payer: Aetna of NY Commercial |
$68.25
|
| Rate for Payer: Aetna of NY Medicare |
$48.30
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$78.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$78.75
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Essential Plan |
$35.08
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicaid |
$15.59
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$38.85
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$52.50
|
| Rate for Payer: Cash Price |
$78.75
|
| Rate for Payer: Cash Price |
$78.75
|
| Rate for Payer: CDPHP Child Health Plus/HARP/Select Plan |
$15.59
|
| Rate for Payer: CDPHP Commercial |
$84.52
|
| Rate for Payer: CDPHP Essential Plan |
$35.08
|
| Rate for Payer: CDPHP Medicare |
$38.85
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$63.00
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$18.71
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$15.59
|
| Rate for Payer: EmblemHealth Medicaid |
$15.59
|
| Rate for Payer: EmblemHealth Medicare |
$35.70
|
| Rate for Payer: EmblemHealth Select Care |
$63.00
|
| Rate for Payer: Fidelis Child Health Plus/Essential Plan/HARP/Medicaid |
$35.08
|
| Rate for Payer: Fidelis Medicare |
$40.02
|
| Rate for Payer: Galaxy Health Commercial |
$68.25
|
| Rate for Payer: Galaxy Health Workers Comp |
$22.92
|
| Rate for Payer: Hamaspik Choice Medicaid |
$1,559.00
|
| Rate for Payer: Hamaspik Choice Medicare |
$38.85
|
| Rate for Payer: Humana Medicare |
$38.85
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$68.25
|
| Rate for Payer: Local 1199SEIU Medicare |
$48.30
|
| Rate for Payer: MVP Health Care of NY Child Health Plus/Family Health Plus/HARP/Medicaid |
$1,559.00
|
| Rate for Payer: MVP Health Care of NY Commercial |
$78.75
|
| Rate for Payer: MVP Health Care of NY Essential Plan 1&2 |
$33.52
|
| Rate for Payer: MVP Health Care of NY Essential Plan 3&4 |
$33.52
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$59.12
|
| Rate for Payer: MVP Health Care of NY Medicare |
$40.79
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$78.75
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$15.59
|
| Rate for Payer: United Healthcare Commercial |
$78.75
|
| Rate for Payer: United Healthcare Medicare |
$38.85
|
| Rate for Payer: WellCare Child Health Plus/Family Health Plus/Medicaid |
$16.37
|
| Rate for Payer: WellCare Medicare |
$57.75
|
|
|
AB; HIV-1 & HIV-2 SGL ASSAY
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
HCPCS 86703
|
| Hospital Charge Code |
4301302
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$68.25 |
| Max. Negotiated Rate |
$68.25 |
| Rate for Payer: Cash Price |
$78.75
|
| Rate for Payer: Galaxy Health Commercial |
$68.25
|
|
|
AB; HSV 1
|
Facility
|
IP
|
$171.00
|
|
|
Service Code
|
HCPCS 86695
|
| Hospital Charge Code |
4301304
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$111.15 |
| Max. Negotiated Rate |
$111.15 |
| Rate for Payer: Cash Price |
$128.25
|
| Rate for Payer: Galaxy Health Commercial |
$111.15
|
|
|
AB; HSV 1
|
Facility
|
OP
|
$171.00
|
|
|
Service Code
|
HCPCS 86695
|
| Hospital Charge Code |
4301304
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.19 |
| Max. Negotiated Rate |
$137.66 |
| Rate for Payer: Aetna of NY Commercial |
$111.15
|
| Rate for Payer: Aetna of NY Medicare |
$78.66
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$128.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$128.25
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$63.27
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$85.50
|
| Rate for Payer: Cash Price |
$128.25
|
| Rate for Payer: Cash Price |
$128.25
|
| Rate for Payer: CDPHP Commercial |
$137.66
|
| Rate for Payer: CDPHP Medicare |
$63.27
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$102.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$136.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$136.80
|
| Rate for Payer: EmblemHealth Medicaid |
$136.80
|
| Rate for Payer: EmblemHealth Medicare |
$58.14
|
| Rate for Payer: EmblemHealth Select Care |
$102.60
|
| Rate for Payer: Fidelis Medicare |
$65.17
|
| Rate for Payer: Galaxy Health Commercial |
$111.15
|
| Rate for Payer: Hamaspik Choice Medicare |
$63.27
|
| Rate for Payer: Humana Medicare |
$63.27
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$111.15
|
| Rate for Payer: Local 1199SEIU Medicare |
$78.66
|
| Rate for Payer: MVP Health Care of NY Commercial |
$128.25
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$96.27
|
| Rate for Payer: MVP Health Care of NY Medicare |
$66.43
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$128.25
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$13.19
|
| Rate for Payer: United Healthcare Commercial |
$128.25
|
| Rate for Payer: United Healthcare Medicare |
$63.27
|
| Rate for Payer: WellCare Medicare |
$94.05
|
|
|
ABO AND RH TYPE
|
Facility
|
OP
|
$366.00
|
|
|
Service Code
|
HCPCS 86900
|
| Hospital Charge Code |
4300011
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$294.63 |
| Rate for Payer: Aetna of NY Commercial |
$237.90
|
| Rate for Payer: Aetna of NY Medicare |
$168.36
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$274.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$274.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$135.42
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$183.00
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: CDPHP Commercial |
$294.63
|
| Rate for Payer: CDPHP Medicare |
$135.42
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$219.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$292.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$292.80
|
| Rate for Payer: EmblemHealth Medicaid |
$292.80
|
| Rate for Payer: EmblemHealth Medicare |
$124.44
|
| Rate for Payer: EmblemHealth Select Care |
$219.60
|
| Rate for Payer: Fidelis Medicare |
$139.48
|
| Rate for Payer: Galaxy Health Commercial |
$237.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$135.42
|
| Rate for Payer: Humana Medicare |
$135.42
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$237.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$168.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$274.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$206.06
|
| Rate for Payer: MVP Health Care of NY Medicare |
$142.19
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$274.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2.99
|
| Rate for Payer: United Healthcare Commercial |
$274.50
|
| Rate for Payer: United Healthcare Medicare |
$135.42
|
| Rate for Payer: WellCare Medicare |
$201.30
|
|
|
ABO AND RH TYPE
|
Facility
|
IP
|
$366.00
|
|
|
Service Code
|
HCPCS 86900
|
| Hospital Charge Code |
4300011
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$237.90 |
| Max. Negotiated Rate |
$237.90 |
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Galaxy Health Commercial |
$237.90
|
|
|
ABO GROUP
|
Facility
|
IP
|
$366.00
|
|
|
Service Code
|
HCPCS 86900
|
| Hospital Charge Code |
4300012
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$237.90 |
| Max. Negotiated Rate |
$237.90 |
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Galaxy Health Commercial |
$237.90
|
|
|
ABO GROUP
|
Facility
|
OP
|
$366.00
|
|
|
Service Code
|
HCPCS 86900
|
| Hospital Charge Code |
4300012
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$294.63 |
| Rate for Payer: Aetna of NY Commercial |
$237.90
|
| Rate for Payer: Aetna of NY Medicare |
$168.36
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$274.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$274.50
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$135.42
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$183.00
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: CDPHP Commercial |
$294.63
|
| Rate for Payer: CDPHP Medicare |
$135.42
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$219.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$292.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$292.80
|
| Rate for Payer: EmblemHealth Medicaid |
$292.80
|
| Rate for Payer: EmblemHealth Medicare |
$124.44
|
| Rate for Payer: EmblemHealth Select Care |
$219.60
|
| Rate for Payer: Fidelis Medicare |
$139.48
|
| Rate for Payer: Galaxy Health Commercial |
$237.90
|
| Rate for Payer: Hamaspik Choice Medicare |
$135.42
|
| Rate for Payer: Humana Medicare |
$135.42
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$237.90
|
| Rate for Payer: Local 1199SEIU Medicare |
$168.36
|
| Rate for Payer: MVP Health Care of NY Commercial |
$274.50
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$206.06
|
| Rate for Payer: MVP Health Care of NY Medicare |
$142.19
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$274.50
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$2.99
|
| Rate for Payer: United Healthcare Commercial |
$274.50
|
| Rate for Payer: United Healthcare Medicare |
$135.42
|
| Rate for Payer: WellCare Medicare |
$201.30
|
|
|
AB; PARVOVIRUS
|
Facility
|
IP
|
$76.00
|
|
|
Service Code
|
HCPCS 86747
|
| Hospital Charge Code |
4304881
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$49.40 |
| Max. Negotiated Rate |
$49.40 |
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Galaxy Health Commercial |
$49.40
|
|
|
AB; PARVOVIRUS
|
Facility
|
OP
|
$76.00
|
|
|
Service Code
|
HCPCS 86747
|
| Hospital Charge Code |
4304881
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.03 |
| Max. Negotiated Rate |
$61.18 |
| Rate for Payer: Aetna of NY Commercial |
$49.40
|
| Rate for Payer: Aetna of NY Medicare |
$34.96
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Blue Access/Small Group |
$57.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) EPO/HMO/Indemnity/PPO |
$57.00
|
| Rate for Payer: Blue Cross Blue Shield of New York (Empire) Medicare |
$28.12
|
| Rate for Payer: Brighton Health (Magnacare) Direct Plus/No Fault/PIP/PPO/Workers Comp |
$38.00
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: CDPHP Commercial |
$61.18
|
| Rate for Payer: CDPHP Medicare |
$28.12
|
| Rate for Payer: EmblemHealth CBP/EPO/PPO/HMO/Network Access |
$45.60
|
| Rate for Payer: EmblemHealth Essential Plan 1/Essential Plan 2 |
$60.80
|
| Rate for Payer: EmblemHealth Essential Plan 3/Essential Plan 4 |
$60.80
|
| Rate for Payer: EmblemHealth Medicaid |
$60.80
|
| Rate for Payer: EmblemHealth Medicare |
$25.84
|
| Rate for Payer: EmblemHealth Select Care |
$45.60
|
| Rate for Payer: Fidelis Medicare |
$28.96
|
| Rate for Payer: Galaxy Health Commercial |
$49.40
|
| Rate for Payer: Hamaspik Choice Medicare |
$28.12
|
| Rate for Payer: Humana Medicare |
$28.12
|
| Rate for Payer: Local 1199SEIU Aetna Signature Administrators |
$49.40
|
| Rate for Payer: Local 1199SEIU Medicare |
$34.96
|
| Rate for Payer: MVP Health Care of NY Commercial |
$57.00
|
| Rate for Payer: MVP Health Care of NY Individual Exchange/Student Health Plan |
$42.79
|
| Rate for Payer: MVP Health Care of NY Medicare |
$29.53
|
| Rate for Payer: Oxford Health Plans Freedom/Liberty/Metro |
$57.00
|
| Rate for Payer: United Healthcare CHIP/Family Health Plus/Medicaid |
$15.03
|
| Rate for Payer: United Healthcare Commercial |
$57.00
|
| Rate for Payer: United Healthcare Medicare |
$28.12
|
| Rate for Payer: WellCare Medicare |
$41.80
|
|
|
ABP MONITORING 24+ HRS; RECORDING
|
Facility
|
IP
|
$366.00
|
|
|
Service Code
|
HCPCS 93786
|
| Hospital Charge Code |
4480039
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$237.90 |
| Max. Negotiated Rate |
$237.90 |
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Galaxy Health Commercial |
$237.90
|
|
